CPR: Synchronized Teamwork

CPR is a complex skill that requires constant training so that it will be performed well under the stress of a critical incident. Mastering breathing and compressions is only one aspect. Lifeguards need to be able to perform CPR without hesitation, effectively use gloves, a resuscitation mask, and an AED. There is also a good chance that a BVM will be incorporated along with emergency oxygen. Depending on the level of training the lifeguards have, suctioning and the use of airway adjuncts like an OPA or NPA may also be utilized for airway management. Lastly, staffing levels will affect the execution of the incident response; responding personnel may range from a single lifeguard to a lifeguard team. Most facilities operate with multiple lifeguards while in service. With this in mind, the drills covered in this article will be broken into 2-rescuer, 3-rescuer, and 4-rescuer responses.

2-RESCUER CPR PROGRESSION DRILL: Both rescuers should be equipped with gloves and resuscitation masks within their fanny packs. Rescuer placement around the victim’s body should be limited to the head (cephalic) and the side (lateral). All drills will be considered a response to a dry victim unless stated. OBJECTIVE: Complete the following skills:

Lifeguards are gloved up

EMS is activated

Primary assessment completed

CPR in progress

TIMING GOAL: 30 seconds for the lifeguard team to complete the objective.

Once the lifeguard team has accomplished the objective within the timing goal, incorporate the progression steps listed below and adjust the timing goal.

Secondary lifeguard has a 5 second delay in arriving on scene (no time change)

Secondary lifeguard has a 10 second delay in arriving on scene (no time change)

BVM is at the scene, needs to be assembled and used after first round of CPR, 2 breaths (add 15 seconds)

BVM is brought by secondary lifeguard who has a 5 seconds delay (add 15 seconds)

BVM is brought by secondary lifeguard who has a 10 seconds delay (add 15 seconds)

Victim is wearing a shirt, which needs to be removed or cut off (no time change). Use actual shirts for this variation.

AED is brought by secondary lifeguard, used on victim with AED analyzing (60 seconds to complete drill). Once this variation is accomplished, reduce the time by 10 seconds.

AED water variation: Same drill variation except it is stated that the victim is removed from water and the chest needs to be dried prior to AED attachment (add 10 more seconds for drying). (Facility note: Consider storing a dry towel with AED.)

2-Rescuer CPR water variation, drying the victim and using BVM and AED

3-RESCUER CPR POSITION DRILL: Lifeguards will move into position around a manikin to provide care. Lifeguards need to avoid clustering and hindering each other. Monitor use of space. OBJECTIVE: Quickly move into proper positions to provide care. Bring the appropriate equipment depending on the combination listed below. Have the lifeguards start 10 feet from the victim.

CPR with BVM useCPR and AEDCPR and AED with BVM use

TIMING GOAL: 5 seconds to complete the objective of getting into proper positions

Once proficient, move to the variations listed below. Variations to 3-rescuer CPR position drill:

Remove one lifeguard after the lifeguard team has positioned themselves. The two lifeguards remaining need to adapt and provide patient care (add 5 seconds)

Add one lifeguard after the team has positioned themselves. The team will need to incorporate the additional lifeguard into the patient care plan, or decide to utilize them for a secondary assignment, e.g., crowd control or incident command (add 5 seconds)

Rescuer position and equipment placemant play large factors in delivering effective CPR

3-RESCUER CPR PROGRESSION DRILL: Rescuers should be equipped with gloves and resuscitation masks within their fanny packs. Rescuer placement around the victim’s body should be limited to the head (cephalic) and the side (lateral). All drills will be considered responses to a dry victim unless stated. OBJECTIVE: Complete the following skills:

All skills from 2-Rescuer CPR Progression Drill

BVM is assembled and ready to use

TIMING GOAL: 30 seconds to complete the objective.

Once the lifeguard team has accomplished the objective within the timing goal, incorporate the progression steps listed below and adjust the timing goal.

Use all progression steps listed for the 2-Rescuer CPR Progression Drill

BVM has emergency oxygen attached and flowing (add 15 seconds) Emergency oxygen will be brought in by secondary lifeguards

Primary lifeguard and secondary lifeguard are stationed at two separate lifeguard towers, tertiary lifeguard is on break, AED/BVM equipment is at in-service storage location. Primary lifeguard initiates victim contact. Drill ends when AED is analyzing victim, and lifeguards are administering proper care (60 seconds to complete drill). Once this variation is accomplished, reduce the time by 10 seconds, then reduce by 5-10 seconds more.

4-RESCUER CPR PROGRESSION DRILL: Rescuers should be equipped with gloves and resuscitation masks within their fanny packs. Rescuer placement around the victim’s body should be limited to the head (cephalic) and the side (lateral). All drills will be considered responses to a dry victim unless stated. OBJECTIVE: Complete the following skills:

All skills from 3-Rescuer Response Progression Drill

AED pads are in place and AED is analyzing

TIMING GOAL: 60 seconds to complete the objective

Once the lifeguard team has accomplished the objective within the timing goal, incorporate the progression steps listed below and adjust the timing goal.

Reduce timing goal from 60 to 50, then to 45, then to 40 seconds

Emergency oxygen is attached and flowing to BVM (add 10 seconds), then repeat with no additional time

If a lifeguard is trained to use, OPA is inserted (no time change)

Change out one rescuer for another rescuer (add 10 seconds), then repeat with no additional time

4-Rescuer CPR with BVM and AED

The beginning of any critical incident is chaotic and stressful. A rapid response with quick effective patient care demonstrates a lifeguard team that has developed an unconscious competence with their skills and a sense of urgency, which is crucial in increasing the chance of saving a life. Train on.

ALL IN THE TIMINGMeeting the Challenge 1-Hour Training Curriculum (12 lifeguards)